Basic Information
Provider Information | |||||||||
NPI: | 1215031851 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | FOUTS | ||||||||
FirstName: | JAMES | ||||||||
MiddleName: | PATRICK | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: | III | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 3407 | ||||||||
Address2: |   | ||||||||
City: | EVANSVILLE | ||||||||
State: | IN | ||||||||
PostalCode: | 477333407 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8124506815 | ||||||||
FaxNumber: | 8124506822 | ||||||||
Practice Location | |||||||||
Address1: | 600 MARY ST | ||||||||
Address2: |   | ||||||||
City: | EVANSVILLE | ||||||||
State: | IN | ||||||||
PostalCode: | 477470001 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8124503405 | ||||||||
FaxNumber: | 8124503099 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/12/2006 | ||||||||
LastUpdateDate: | 07/21/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 34864 | KY | N |   | Allopathic & Osteopathic Physicians | Emergency Medicine |   | 207P00000X | 01053587A | IN | Y |   | Allopathic & Osteopathic Physicians | Emergency Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 000000381078 | 01 | IN | BCBS - GATEWAY | OTHER | 64438641 | 05 | KY |   | MEDICAID | 070163 | 01 | IN | HAMP # | OTHER | 614066 | 01 | IN | HEALTHLINK # | OTHER | 1951571 | 01 | IN | FIRST HEALTH # | OTHER | 200320890 | 05 | IN |   | MEDICAID | 323118214 PYE 1 | 05 | IL |   | MEDICAID | 000000195763 | 01 | IN | BCBS - MARY STREET | OTHER | 7240252 | 01 | IN | AETNA # | OTHER |